Introduction: The number of patients with end-stage kidney disease is increasing worldwide, creating an unprecedented organ shortage. The kidney is a highly complex structure performing many crucial functions. Dialysis replaces filtration but not all other kidney functions and transplant is limited by kidney availability. Numerous innovative ways are being explored to obtain new kidneys for disease modeling and potentially replace lost kidney functions.Areas covered: In this review, we will go through the different approaches that have been developed over the years to build kidneys. We will first present the current advances in xenotransplantation and generation of interspecies chimeras. Next, we will examine the attempts to create bioengineered kidneys with hemodialysis-derived implantable devices and decellularized organs. Finally, we will examine how organoids and microfluidic devices could answer important pathophysiological questions and model the path toward creating in vitro functional organs, for example through 3D bioprinting.Expert opinion: While all the aforementioned approaches to create new kidneys are promising, their translation into clinical practice seems a long way off, except xenotransplantation. Nonetheless, these novel technologies already consent disease modeling and drug testing at 3D level. We will review the stages of progress toward patient therapy and advantages/drawbacks of the various strategies.

中文翻译：

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肾脏科医生的生物工程策略：肾脏不是一天建成的。

简介：在世界范围内，患有终末期肾脏疾病的患者数量正在增加，造成了前所未有的器官短缺。肾脏是执行许多关键功能的高度复杂的结构。透析代替了过滤，但并非所有其他肾脏功能都受到了限制，并且移植受到肾脏可用性的限制。正在探索多种创新方法来获得用于疾病建模的新肾脏，并有可能替代失去的肾功能。涉及的领域：在本综述中，我们将介绍多年来建立肾脏的各种方法。我们将首先介绍异种移植和种间嵌合体产生的最新进展。接下来，我们将研究使用血液透析衍生的可植入设备和脱细胞器官创建生物工程肾脏的尝试。最后，我们将研究类器官和微流控设备如何回答重要的病理生理问题，并通过3D生物打印等方法模拟创建体外功能器官的途径。专家意见：尽管上述创建新肾脏的方法都有希望，但它们已转化为临床实践除了异种移植，似乎还有很长的路要走。尽管如此，这些新颖的技术已经同意在3D级别进行疾病建模和药物测试。我们将回顾患者治疗的进展阶段以及各种策略的优点/缺点。尽管上述所有创建新肾脏的方法都有希望，但它们的移植到临床实践中似乎还有很长的路要走，除了异种移植。尽管如此，这些新颖的技术已经同意在3D级别进行疾病建模和药物测试。我们将回顾患者治疗的进展阶段以及各种策略的优点/缺点。尽管上述所有创建新肾脏的方法都有希望，但它们的移植到临床实践中似乎还有很长的路要走，除了异种移植。尽管如此，这些新颖的技术已经同意在3D级别进行疾病建模和药物测试。我们将回顾患者治疗的进展阶段以及各种策略的优点/缺点。